Keiko Matsuura

Traditional Japanese Kampo Medicine: Clinical Research between Modernity and Traditional Medicine—The State of Research and Methodological Suggestions for the Future

The Japanese traditional herbal medicine, Kampo, has gradually reemerged and 148 different formulations (mainly herbal extracts) can be prescribed within the national health insurance system. The objective of this article is to introduce Kampo and to present information from previous clinical studies that tested Kampo formulae. In addition, suggestions on the design of future research will be stated. The literature search was based on a summary, up until January 2009, by the Japanese Society of Oriental Medicine and included only those trials which were also available in either Pubmed or ICHUSHI (Japan Medical Abstracts Society). We included 135 studies, half of these studies (n = 68) used a standard control and 28 a placebo control. Thirty-seven trials were published in English [all randomized controlled trials (RCTs)] and the remaining articles were in Japanese only. The sample size for most studies was small (two-third of the studies included less than 100 patients) and the overall methodological quality appeared to be low. None of the studies used Kampo diagnosis as the basis for the treatment. In order to evaluate Kampo as a whole treatment system, certain aspects should be taken into account while designing studies. RCTs are the appropriate study design to test efficacy or effectiveness; however, within the trial the treatment could be individualized according to the Kampo diagnosis. Kampo is a complex and individualized treatment with a long tradition, and it would be appropriate for further research on Kampo medicine to take this into account.

Phase separation of myelin sheath in Triton X-114 solution: predominant localization of the 21.5-kDa isoform of myelin basic protein in the lipid raft-associated domain

Myelin basic protein (MBP) isoforms in the myelin sheath are known to have distinct intracellular expression patterns, which are profoundly related to functional specificity. Determining the differential localization of MBP isoforms is therefore important for understanding their pathophysiological roles. In this study, we have developed a new method for phase separation of myelin. The non-ionic detergent Triton X-114 is used to solubilize myelin sheath which then undergoes phase separation to yield four fractions. The lipid raft-associated proteins and lipids in each fraction were analysed by immunoblotting and lipid analysis, respectively. The present method gives two lipid raft-enriched fractions, one of them was found to contain only lipid raft-associated galactocerebroside and cholesterol as the major lipids. The 21.5-kDa MBP isoforms (21.5 MBP), both unphosphorylated and phosphorylated, were exclusively contained in this fraction. Phosphorylated 21.5 MBP (21.5 pMBP) has been shown to specifically disappear from demyelinated loci. The present analytical method clearly indicated that disappearance of 21.5 pMBP corresponded to demyelination and its reappearance corresponded to prevention of demyelination. Demyelination was also associated with aging and was prevented by the myelin-protecting herbal medicine, Chinpi, a type of dried citrus peel.

Clustering for visual analogue scale data in symbolic data analysis

Abstract We propose a hierarchical clustering for the visual analogue scale (VAS) in the framework of Symbolic Data Analysis(SDA). The VAS is a method that can be readily understood by most people to measure a characteristic or attitude that cannot be directly measured. VAS is of most value when looking at change within people, and is of less value for comparing across a group of people because they have different sense. It could be argued that a VAS is trying to produce interval/ratio data out of subjective values that are at best ordinal. Thus, some caution is required in handling VAS. We describe VAS as distribution and handle it as new type data in SDA. In this paper, we define “VAS distribution” as new type data in SDA and propose a hierarchical clustering for this new type data.

Symbolic Hierarchical Clustering for Pain Vector

We propose a hierarchical clustering in the framework of Symbolic Data Analysis(SDA). SDA was proposed by Diday at the end of the 1980s and is a new approach for analysing huge and complex data. In SDA, an observation is described by not only numerical values but also “higher-level units”; sets, intervals, distributions, etc. Most SDA works have dealt with only intervals as the descriptions. We already proposed “pain distribution” as new type data in SDA. In this paper, we define new “pain vector” as new type data in SDA and propose a hierarchical clustering for this new type data.

International Classification of Diseases

受付:2009年11月6日,受理:2010年7月11日 Abstract Traditional East Asian medicines, Kampo included, are to be incorporated into International Classification of Diseases 11 (ICD-11) which will be released in 2015. To understand the significance of this plan, ICD itself needs to be understood. In this article, we describe ICD history, its significance and problems, and why the WHO became interested in traditional medicine. In the beginning, the ICD was only for classifying causes of mortality, and has since expanded to cover disease information according to the diverse needs of a changing society. And in Japan today, it is widely used not only for death certificate and disease information, but also for research purposes. There are many problems with the ICD, however : e.g. it is not clinically convenient, and it lacks certain terminology. Revision from IDC-10 to ICD-11 is now ongoing. It will be expanded and electronic. At the same time, plans are to have it broadly implemented in Asia by including traditional East Asian medicine.

Symbolic hierarchical clustering for visual analogue scale data

We propose a hierarchical clustering in the framework of Symbolic Data Analysis(SDA). SDA was proposed by Diday at the end of the 1980s and is a new approach for analysing huge and complex data. In SDA, an observation is described by not only numerical values but also “higher-level units”; sets, intervals, distributions, etc. Most SDA works have dealt with only intervals as the descriptions. In this paper, we define “pain distribution” as new type data in SDA and propose a hierarchical clustering for this new type data.

Current Problems of the Compound Fee for Herbal Medicine

2006年度に改定された漢方生薬の調剤である湯薬調剤料が適正であるか否かを検討した。調剤時間を指標に湯薬調剤と一般調剤を比較した。1～15日処方で一般調剤が平均4．4分／枚のところ湯薬調剤は平均13．4分／枚と約3倍の時間を要し，30日を超過する処方では一般調剤に比べ約7倍の時間を要した。次に調剤業務1分間あたりの調剤報酬を湯薬調剤と一般調剤で比較検討した。1～15日処方では大きな差はなかったが，15日を超える処方日数の湯薬調剤では一般調剤に比べ，調剤報酬が約1／3から1／5ほど低い結果となった。大学病院における処方日数の変移の調査では，30日を超過する処方件数は2003年度では全体の2．7％であったが，2008年度の件数は約14倍に増えて全体の42％であった。長期投薬が増えつつある現状を考慮すると，湯薬調剤料も内服調剤料同様，処方日数に応じた調剤報酬にする必要がある。